Basic Information
| Provider Information | |||||||||
| NPI: | 1528043056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AESCHLIMAN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1234 E DUPONT RD | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468251545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2603739700 | ||||||||
| FaxNumber: | 2603739740 | ||||||||
| Practice Location | |||||||||
| Address1: | 10515 ILLINOIS RD | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468149182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2603739200 | ||||||||
| FaxNumber: | 2603739219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2005 | ||||||||
| LastUpdateDate: | 03/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01026984A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00000239210 10 | 01 | UNITED HEALTHCARE | OTHER | 4204133 | 01 | AETNA | OTHER | 000000111792 | 01 | IN | ANTHEM | OTHER | 100354510 | 05 | IN | MEDICAID | 1015 | 01 | IN | PHYSICIANS HEALTH PLAN | OTHER | 3937240015 | 01 | IN | MEDICARE DMEPOS | OTHER |